Supplementary medical insurance for enterprises is a form of supplementary medical insurance encouraged by the state and organized or participated by enterprises independently on the basis of participating in urban basic medical insurance. The enterprise factors that affect the payment of commercial supplementary medical insurance mainly include: the work content of the enterprise, the health and welfare status, the level of medical expenses in the past, and the age structure of the insured enterprises. First, supplementary medical insurance for enterprises The supplementary medical insurance fund is used for enterprises to participate in local basic medical insurance in accordance with the regulations. In addition to the treatment paid by the basic medical insurance system for urban employees, the medical expenses paid by individual employees are given appropriate subsidies to reduce the burden of medical expenses for insured employees. The part of enterprise supplementary medical insurance premiums within 4% of the total wages can be directly charged from the cost, and is no longer approved by the financial department at the same level. Enterprises and institutions with basic medical insurance can establish supplementary medical insurance. The supplementary medical insurance measures for enterprises should be linked with the local basic medical insurance system. The supplementary medical insurance fund for enterprises is used and managed by enterprises or industries in a centralized way, and is managed by separate accounts. Medical expenses subsidies for employees and retirees with heavy personal burdens in enterprises shall not be included in the personal accounts of basic medical insurance, nor shall they be set up separately or used for other expenses of employees in disguise. The financial department and the labor and social security department should strengthen the supervision and financial supervision over the management of supplementary medical insurance funds of enterprises, and prevent illegal acts such as misappropriation of funds. Second, the purchase principle of commercial insurance 1, protect adults first, then protect children. Most parents will consider making a comprehensive protection plan for their children after they have children. Meanwhile, parents often neglect to buy insurance for themselves. In fact, for children, the greatest protection comes from parents. Once something happens to the parents on whom the children depend, especially the children without any financial ability, they really lose the most basic protection. Therefore, buying insurance should follow a basic principle: first, protect parents, especially those who make the greatest contribution to family finance. 2. First meet the security needs and then consider the investment needs. To buy insurance, you must first meet your own protection needs, and then consider the investment needs. There is no basic guarantee, let alone other investments once the insured appears. Therefore, we should consider meeting the basic guarantee first, and then consider others. 3. Meet the insurance demand first, and then consider the premium expenditure. When purchasing, meet the insurance demand first, and then consider the premium expenditure. This is mainly because the insured amount is more important than the premium. As a necessary guarantee, it is meaningless to buy too little, and it is no longer affordable to buy too much. So it is appropriate to choose a suitable range. In addition, the premium needs to be adjusted according to the actual situation of the insured. Different personal stages, different financial conditions and different occupational categories can arrange your premium expenses in different ways, and consumers can achieve the amount of insurance they need through reasonable combination. 4. Meet life insurance first, then consider property insurance. Most people think that property insurance should be considered first, but they often neglect to insure themselves with life insurance; There are also many business owners who will insure property insurance for their enterprises instead of personal insurance for themselves. This actually has the problem of putting the cart before the horse. 5. Meet the insurance plan first, and then consider the insurance products. Generally speaking, the purchase of commercial insurance should conform to the insurance plan first, and then consider the insurance products, which is more conducive to the comprehensive protection of the insured and the maximization of interests. Three. Types of commercial insurance 1. According to the number of policyholders, it can be divided into individual health insurance and group health insurance. 2. According to the insurance period, it can be divided into short-term health insurance and long-term health insurance. The length of insurance period can also be combined with the number of policyholders to form short-term group insurance and long-term group insurance, and can also be combined with individuals to form short-term individual insurance and long-term individual insurance. 3. According to the classification of insurance liability (1), sickness insurance refers to insurance that pays insurance benefits on the condition of illness, that is, as long as the insured suffers from a certain disease listed in the insurance clauses, he can get fixed compensation regardless of whether or not medical expenses occur or how much expenses occur. (2) Medical Insurance Medical insurance, also known as medical expense insurance, refers to the insurance that compensates the expenses incurred by the insured when receiving medical services. (3) Disability insurance Disability insurance, also known as income loss insurance and income protection insurance, refers to insurance that causes income and property losses due to the insured's loss of working ability. 4. According to the types of losses, it can be divided into medical expense insurance, disability income loss insurance and long-term care insurance. 5. According to different payment methods, we can classify (1) expense insurance. Based on the reasonable medical expenses incurred by the insured in the process of medical treatment, the insurer shall compensate all or part of the medical expenses in accordance with the provisions of the insurance contract. (2) Subsidized insurance (fixed payment insurance). Subsidized insurance refers to the insurance that pays the insurance premium according to the standard agreed in the insurance contract regardless of the actual expenditure of the insured. (3) Provide service-oriented products. In the process of providing such products, the insurer directly participates in the management of the medical service system. The insurer selects medical service providers (hospitals, clinics and doctors) according to certain standards, and organizes the selected medical service providers to provide medical services for the insured. There are strict and formal operating procedures to ensure the quality of service, and the use of medical services is often audited. Insured people can enjoy economic benefits by looking for designated medical service institutions according to the prescribed procedures. To sum up, the characteristics of commercial supplementary medical insurance are: settlement according to service items; Settlement by service unit; Be able to make a reasonable choice for the insured enterprise or the insured; Be able to design additional clauses according to specific conditions; Can be closely combined with medical insurance, * * * and the control of moral hazard.

Legal objectivity:

The Interim Measures for Supplementary Medical Insurance for Enterprises in Beijing clearly stipulates that enterprises participating in Beijing's basic medical insurance can establish supplementary medical insurance for their employees and retirees (foreign-invested enterprises are limited to Chinese employees), and at the same time make specific provisions on the extraction and payment of supplementary medical insurance premiums. This method aims to implement the Regulations of Beijing Municipality on Basic Medical Insurance and ensure the smooth transition of the medical insurance system. The measures are as follows: Article 1 In order to improve the medical security level of employees and retirees, these measures are formulated in accordance with the Provisions of Beijing Municipality on Basic Medical Insurance (Order No.68 +0 of Beijing Municipal People's Government on February 20, 2006). Article 2 Supplementary medical insurance is a supplementary form of basic medical insurance. Enterprises participating in Beijing's basic medical insurance can establish supplementary medical insurance for their employees and retirees (foreign-invested enterprises are limited to Chinese employees). Enterprise supplementary medical insurance is mainly used to solve the medical expenses borne by retirees and the medical expenses that employees need to pay for hospitalization. Article 3 If the supplementary medical insurance premium is less than 4% of the total wages of the employees of this enterprise in the previous year, it shall be charged from the cost. Article 4 Supplementary medical insurance premiums pay the following expenses incurred by employees and retirees in designated medical institutions and retail pharmacies: (1) Medical expenses when personal accounts are insufficient; (two) medical expenses paid by individuals other than the basic medical insurance fund; (three) in addition to the mutual fund to pay large medical expenses, medical expenses should be paid by individuals. Article 5 The scope of payment of supplementary medical insurance for enterprises can be determined by referring to the Provisions of Beijing Municipality on Designated Medical Care of Basic Medical Insurance and the list of drugs, diagnosis and treatment items, service facilities and payment standards of basic medical insurance. The specific payment ratio is determined by the enterprise. Article 6 The balance of supplementary medical insurance premiums of enterprises in the current year shall be carried forward to the next year for use. Article 7 Supplementary medical insurance shall be managed by enterprises. Enterprises should formulate specific management measures according to these measures. The specific management measures and annual budget plan of supplementary medical insurance for enterprises must be reviewed by the general meeting of employees (representatives), and the joint-stock enterprises must also be reviewed by the shareholders' meeting and the board of directors. The implementation of supplementary medical insurance by enterprises shall be reviewed by the staff (representative) meeting and announced to all employees. Eighth other employers who do not enjoy the national civil service Medicaid may establish supplementary medical insurance with reference to these measures. Article 9 An employing unit that establishes supplementary medical insurance shall register with the district or county medical insurance agency in the insured area before June 30 every year and declare the capital expenditure for one year. Tenth approach by the Municipal Labor and Social Security Bureau is responsible for the interpretation of. Article 11 These Measures shall come into force as of April 1 2006. The promulgation of this method requires a full understanding of the significance of establishing supplementary medical insurance for enterprises, and requires qualified enterprises to establish supplementary medical insurance for enterprises, while highlighting key issues.